Form Rv-5 - Amended Rental Motor Vehicle And Tour Vehicle Surcharge Tax Return - 2009

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Clear Form
79
FORM RV-5
STATE OF HAWAII—DEPARTMENT OF TAXATION
DO NOT WRITE IN THIS AREA
—AMENDED—
(REV. 2009)
RENTAL MOTOR VEHICLE AND TOUR VEHICLE
SURCHARGE TAX
NAME: _____________________________________________
MONTH OF_________________ , ________
(Do not combine your filing for more than one month, if filing monthly.)
W_ _ _ _ _ _ _ _ - _ _
QUARTER OF __________________ , ________
HAWAII TAX I.D. NO.
(Do not combine your filing for more than one quarter, if filing quarterly.)
_ _ _ _
SEMIANNUAL PERIOD OF _______________ , _______
LAST 4 DIGITS OF YOUR FEIN OR SSN:
(Do not combine your filing for more than one semiannual period, if filing semiannually.)
THIS FORM SHOULD NOT BE USED AFTER THE ANNUAL RETURN AND RECONCILIATION HAS BEEN FILED.
COLUMN A
COLUMN B
COLUMN C
Rental Motor Vehicle
Tour Vehicle Surcharge Tax
Tour Vehicle Surcharge Tax
Surcharge Tax — Enter the
Enter the Number of Tour
Enter the Number of Tour
Number of Rental Motor Vehicle
Vehicles Carrying 8 - 25
Vehicles Carrying 26 or More
Days
Passengers
Passengers
1 OAHU DISTRICT
1
2 MAUI DISTRICT
2
3 HAWAII DISTRICT
3
4 KAUAI DISTRICT
4
5 TOTALS
(Add lines 1 thru 4 of
5
Columns A, B, and C)
6 RATES
$3
$15
$65
6
7 TAXES
(Multiply line 5 by line 6 of
00
00
00
7
Columns A, B, and C)
8 TOTAL TAXES DUE
8
(ADD LINE 7, Columns A thru C, AND ENTER HERE)
9
9
PENALTY
10
10
INTEREST
11
11
TOTAL AMOUNT DUE (ADD LINES 8, 9, AND 10; ENTER AMOUNT HERE)
12
12
12
TOTAL TAXES PAID FOR THE PERIOD
13
13
ADDITIONAL ASSESSMENTS PAID FOR THE PERIOD IF INCLUDED ABOVE
13
14
14
PENALTIES $___________ INTEREST $___________ PAID DURING THE PERIOD
14
15
15
TOTAL PAYMENTS MADE (ADD LINES 12, 13, AND 14)
16
16
IF LINE 15 IS LARGER THAN LINE 11, ENTER CREDIT TO BE REFUNDED (LINE 15 MINUS LINE 11)
17
17
IF LINE 11 IS LARGER THAN LINE 15, ENTER TAXES DUE (LINE 11 MINUS LINE 15)
18a
18a
Penalty
FOR LATE FILING ONLY
18b
18b
Interest
19
19
TOTAL TAXES NOW DUE AND PAYABLE (ADD LINES 17, 18a AND 18b)
20
20
PLEASE ENTER AMOUNT OF YOUR PAYMENT (PAY IN U.S. DOLLARS ONLY)
At tach your check or money order payable to “HAWAII STATE TAX COLLECTOR” in U.S. dollars drawn on any U.S. bank to Form RV-5. Write “RV”, the
filing period, and your Hawaii Tax I.D. No. on your check or money order.
I declare, under the penalties set forth in section 231-36, HRS, that this is a true and correct return, prepared in
accordance with the provisions of the Rental Motor Vehicle and Tour Vehicle Surcharge Tax Law and the rules
issued thereunder.
IN THE CASE OF A CORPORATION OR PARTNERSHIP, THIS RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR MEMBER, OR DULY AUTHORIZED AGENT.
SIGNATURE
TITLE
DATE
(
)
DAYTIME PHONE NUMBER:
—
—
MAILING ADDRESS
Hawaii Department of Taxation
P. O. Box 2430
79
FORM RV-5
THIS SPACE FOR DATE RECEIVED STAMP
Honolulu, HI 96804-2430

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